Exenatide

How it works

It activates GLP-1 receptors to stimulate glucose-dependent insulin secretion, suppress inappropriate glucagon release, slow gastric emptying and increase satiety.

Prescribing in practice

• It has been associated with acute pancreatitis, so it should be stopped and not restarted if pancreatitis is suspected.
• Gastrointestinal effects, especially nausea, are common, and the prolonged-release formulation must not be confused with the immediate-release product.
• Hypoglycaemia risk is increased when combined with a sulfonylurea or insulin, which may need dose reduction, and it is not recommended in severe renal impairment.

Monitoring

Monitor HbA1c and renal function, and review gastrointestinal tolerability after initiation and dose changes.

Counselling the patient

• Stop the medicine and seek urgent advice for severe, persistent abdominal pain.
• Nausea is common early on and usually settles; take as directed for your specific formulation.
• Report symptoms of low blood sugar, especially if you also take a sulfonylurea or insulin.

Evidence & guidelines

NICE recommends GLP-1 receptor agonists such as exenatide for type 2 diabetes within defined treatment criteria.